Headaches/Pain

QUESTION:

I have experienced severe headaches ever since the brain injury I sustained several years ago. The pain occurs in the area where I sustained the injury. Is it possible to completely get rid of this pain? If not, what can I do at least to alleviate the head pain?

ANSWER

Post-traumatic headache is a common somatic/physical complaint following cranial trauma, cervical injury, as well as brain injury. Your complaints of localized pain at the site of your injury certainly suggests that your headaches may be due to a couple of different variants of post-traumatic headache for which there are at least eight different possible causes, when looking at headache as a global complaint following these types of injuries. No clinician can adequately diagnose a problem like this without examining the patient; however, based on your complaint, my guess is that you would be more likely to have a local musculoskeletal problem and/or a neuritic type of pain (pain emanating from damage to small nerves in the scalp) as potential causes of your current headache condition. If your headache is due to one or a combination of these factors, then certainly it is well within reason to expect that your headache could be modulated, e.g. diminished if not cured, with appropriate treatment. Appropriate treatment may include oral medications, specific types of physical and/or manual medicine therapy, trigger point injections, nerve blocks, local application of ice or heat, and topical administration of certain medications to the painful area. It is also important to address psychoemotional aspects of chronic pain whether involving headaches or other types of pain following these types of traumatic injuries. Therefore, appropriate assessment by a pain specialist, preferably in conjunction with psychological assessment and/or treatment should definitely be considered. Additional techniques, including biofeedback training and/or relaxation training, also could be considered depending upon the ultimate diagnosis for your headache condition. I should point out that many times patients are given the diagnosis of "post-traumatic headache." It is important for the patient as well as the physician to seek out a cause for the headache condition rather than just confirming the symptom, e.g. headache. Hopefully by identifying the cause of the pain, one can provide more directed treatment to cure and/or diminish the headache condition.
QUESTION:

Due to a traumatic brain injury, I experience severe headaches during which I am so sensitive to light and sound that I have to lie down in a completely quiet, darkened room alone. This hypersensitivity has not dissipated and I am worried that I’ll have to endure this for the rest of my life. Is this normal? What can I do to help myself?

ANSWER
Headaches are a common problem after traumatic brain injury, occurring in more than 50% of individuals. There is no relationship between severity of injury and incidence or intensity of headaches; in fact, individuals with mild injuries may have a greater incidence due to primary cervical musculature injury. Headaches after TBI may be due to: 1) the presence of blood within the brain (usually subarachnoid blood) which irritates the meninges (lining of the brain), 2) bony injury to the skull and neck, and 3) injury, bruising, or scarring of the muscles over the skull and neck (most common). Predicting who will have a headache is difficult. The vast majority of individuals with headache will have rapid resolution in the first 1-3 months. The remaining individuals will usually improve over the next year. Folks with headaches remaining by 6 months after injury can expect some recovery, but total resolution is unlikely. Things that facilitate early recovery include: 1) appropriate diagnosis and treatment of any secondary conditions of the muscle, skull, or brain, 2) rapid mobilization out of bed, out of chair, and back to full function, 3) early, regular stretching/range of motion (ROM) of the neck and shoulders, 4) early use of scheduled anti-inflammatory medications (Ibuprofen, etc.) and Tylenol (avoidance of addictive or narcotic medications), 5) appropriate management of sleep disorders, 6) regular, appropriate aerobic activity. Medications which help when the standard ones do not include (with the supervision of a medical doctor): Fiorinol, Midrin, Elavil, Paxil, Cafergot, Propranolol.

QUESTION:

I have significant residual pain since my injury one year ago. My back, neck and head continue to hurt, and I have difficulty walking (stiffness, aching). I did not receive much in the way of physical therapy after the injury, and I have not been to a doctor recently other than my family physician. Is there a specialist who can address my pain and walking difficulties?

ANSWER
Pain issues following significant trauma certainly are not uncommon. It is unclear based on your question whether your pain is continuing to be a problem due to musculoskeletal or neurologic problems. Certainly, a combination of these factors might be responsible for your pain difficulties. Since many people with traumatic brain injury have their accidents as a result of motor vehicle mishaps, it is not uncommon that they also have concurrent problems with what has been technically termed as "acceleration/deceleration" injuries (commonly termed whiplash injuries). Many different types of problems can result in head, neck and back pain including chronic myofascial pain, misalignment of spinal vertebra (technically referred to as spinal somatic dysfunction), herniated discs, radiculopathies (nerve root injury/irritation), body asymmetries and poor postural issues as well as stress, among many other possibilities. Many of these disorders, particularly back pain, can adversely affect the way in which you walk. Walking difficulties in and of themselves may be caused by a variety of different conditions including both neurologic and musculoskeletal ones and even certain types of psychoemotional problems. Based on the complexity of assessing persons with your types of problems, I would strongly recommend that you see a specialist in neurologic rehabilitation (either a physiatrist or neurologist) who has had adequate experience in dealing with similar types of issues.

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